Journal article
Do patients with a PI-RADS 5 lesion identified on magnetic resonance imaging require systematic biopsy in addition to targeted biopsy?
Urologic oncology, Vol.39(4), pp.235.e1-235.e4
04/2021
DOI: 10.1016/j.urolonc.2020.12.015
PMID: 33451935
Abstract
Do Patients with a PI-RADS 5 Lesion Identified on Magnetic Resonance Imaging Require Systematic Biopsy in Addition to Targeted Biopsy?•MRI-targeted biopsy alone may be sufficient in the setting of a PI-RADS 5 lesion.•The addition of systematic biopsy did not change clinical management.•Omission of systematic biopsy could be considered in this setting.
Magnetic Resonance Imaging (MRI)-targeted prostate biopsy (MRI-TB) improves the detection of prostate cancer. These biopsies typically involve both a 12-core systematic biopsy (SB) and MRI-TB of the lesion. Since the majority of PI-RADS 5 lesions represent clinically significant cancers, the utility of SB in addition to MRI-TB is unclear. We evaluate the utility of SB in the setting of PI-RADS 5 lesions in biopsy naïve and active surveillance patients.
Patients undergoing MRI-TB+SB with a PI-RADS 5 lesion were retrospectively reviewed in a prospectively collected database. Pathology obtained from the MRI-TB was then compared to that of the SB, and each was reported based on the highest Gleason Grade from the sample. In patients with a prior biopsy, we identified instances in which the MRI-TB+SB resulted in upgraded pathology and further subdivided these patients based on whether the pathology upgrade was a result of the TB or the SB.
We identified PI-RADS 5 lesions in 97 patients. All lesions biopsied were found to be prostate cancer, and 86.9% were clinically significant. Gleason Grade from the MRI-TB of the PI-RADS 5 lesions was the same or higher to that of the SB in all but 3 cases (3.1%). Among 59 patients with a prior prostate biopsy, 54 had upgraded pathology from MRI-TB+SB (91.5%). Of these 54 patients, MRI-TB pathology of the PI-RADS 5 lesion was the same or higher to that of the SB in 52 patients (96.3%). In all patients with higher Gleason Grade on SB than MRI-TB, the MRI-TB demonstrated GG3 or higher and SB did not change subsequent clinical management.
In the presence of a PI-RADS 5 lesion, SB offers minimal additional clinical value and could potentially be omitted when performing MRI-TB.
Details
- Title: Subtitle
- Do patients with a PI-RADS 5 lesion identified on magnetic resonance imaging require systematic biopsy in addition to targeted biopsy?
- Creators
- Justin N. Drobish - University of Iowa Hospitals and ClinicsMark D. Bevill - University of Iowa Hospitals and ClinicsChad R. Tracy - University of IowaShawn M. Sexton - Roy J. and Lucille A. Carver College of MedicineMaheen Rajput - University of IowaCatherine M. Metz - University of IowaPaul T. Gellhaus - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Urologic oncology, Vol.39(4), pp.235.e1-235.e4
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.urolonc.2020.12.015
- PMID
- 33451935
- ISSN
- 1078-1439
- eISSN
- 1873-2496
- Grant note
- UL1TR002537 / University of Iowa Clinical and Translational Science Award - NIH 30-546-030 / University of Iowa Hospitals and Clinics Department of Urology
- Language
- English
- Date published
- 04/2021
- Academic Unit
- Radiology; Urology
- Record Identifier
- 9984318720602771
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